Elevate Bridgeport

Divine ID

Every Wednesday starting March 11th

from 3:00 pm to 4:30 pm

Student First name

Student Last name

Student Phone

Student Email

Parent/Guardian Name

Parent/Guardian Contact Phone

Emergency Contact Name

Emergency Contact Phone

What school do you attend?

What grade are you in?

I give permission for my child to go with Elevate Bridgeport Staff to the Elevate Office.

I hereby grant Elevate Bridgeport permission to use my likeness in a photograph, video, or other digital media in any and all it's publications and social media.

Elevate Bridgeport

Divine ID

Due to all the accumulated snow days and the revision to April Break, we are cancelling this trip. All monies will be returned.

Due to all the accumulated snow days and the revision to April Break, we are cancelling this trip.
All monies will be returned.